The apotropaic usage of the sign can also be seen in Italy and in other Mediterranean cultures where, when confronted with unfortunate events, or simply when these events are mentioned, the sign of the horns may be given to ward off bad luck. It is also used traditionally to counter or ward off the "evil eye" (malocchio in Italian). In Italy specifically, the gesture is known as the corna. With fingers pointing down, it is a common Mediterranean apotropaic gesture, by which people seek protection in unlucky situations (It is thus a more Mediterranean equivalent of knocking on wood). Thus, for example, the President of the Italian Republic, Giovanni Leone, shocked the country when, while in Naples during an outbreak of cholera, he shook the hands of patients with one hand while with the other behind his back he superstitiously made the corna, presumably to ward off the disease or in reaction to being confronted by such misfortune. This act was well documented by the journalists and photographers who were right behind him, a fact that had escaped President Leone's mind in that moment.

In Italy and other parts of the Mediterranean region, the gesture must usually be performed with the fingers tilting downward to signify the warding off of bad luck; in the same region and elsewhere, the gesture may take a different, offensive and insulting meaning if it is performed with fingers upward or if directed aggressively towards someone in a swiveling motion (see section below). In Italy, one can also "touch iron" (tocca ferro) or touch one's nose to ward off bad luck. Males in Italy may also grab their testicles when confronted by bad luck; however, this is considered more vulgar.

In Peru one says contra (against). In the Dominican Republic the expression is zafa, said against curses known as fukú. All of these gestures are meant to conjure supernatural protection.

The sign of the horns is used during religious rituals in Wicca, to invoke or represent the Horned God.[4]

On the cover of the Beatles' Yellow Submarine album (1969), the cartoon of John Lennon's right hand is making the sign above Paul McCartney's head. Some fans interpreted this as one of the many supposed "Paul is dead" clues. Some may think it is possible that the cartoonist misrepresented the sign for "I love you", which is very similar and more in keeping with the band's public message and image. However, the 1969 cartoon is based on many photos of John Lennon making the hand sign in 1967. One of these photos of Lennon doing the hand sign appears on the cover of a Beatles single release shortly after, making it the first time the hand sign appears on a rock release.

The sign is also used in various Disney movies. It can be seen in the medieval-style opening sequence of the 1971 British-American Disney movie Bedknobs and Broomsticks as a goat-legged figure with a jester's cap leading a procession of outlandish looking figures, flashes the sign.

Ronnie James Dio was known for popularizing the sign of the horns in heavy metal.[11][13] He claimed his Italian grandmother used it to ward off the evil eye (which is known in Southern Italy as malocchio). Dio began using the sign soon after joining the metal band Black Sabbath in 1979. The previous singer in the band, Ozzy Osbourne, was rather well known for using the "peace" sign at concerts, raising the index and middle finger in the form of a V. Dio, in an attempt to connect with the fans, wanted to similarly use a hand gesture. However, not wanting to copy Osbourne, he chose to use the sign his grandmother always made.[14] The horns became famous in metal concerts very soon after Black Sabbath's first tour with Dio. The sign would later be appropriated by heavy metal fans under the name "maloik", a corruption of the original malocchio.[citation needed]

When asked if he was the one who introduced the hand gesture to metal subculture, Dio said in a 2001 interview with Metal-Rules.com:

I doubt very much if I would be the first one who ever did that. That's like saying I invented the wheel, I'm sure someone did that at some other point. I think you'd have to say that I made it fashionable. I used it so much and all the time and it had become my trademark until the Britney Spears audience decided to do it as well. So it kind of lost its meaning with that. But it was.... I was in Sabbath at the time. It was a symbol that I thought was reflective of what that band was supposed to be all about. It's NOT the devil's sign like we're here with the devil. It's an Italian thing I got from my Grandmother called the "Malocchio". It's to ward off the Evil Eye or to give the Evil Eye, depending on which way you do it. It's just a symbol but it had magical incantations and attitudes to it and I felt it worked very well with Sabbath. So I became very noted for it and then everybody else started to pick up on it and away it went. But I would never say I take credit for being the first to do it. I say because I did it so much that it became the symbol of rock and roll of some kind.[15]

Gene Simmons of the rock group KISS attempted to claim the "devil horns" hand gesture for his own. According to CBS News, "Simmons filed an application Friday, June 16, 2017 with the U.S. Patent and Trademark Office for a trademark on the hand gesture he regularly uses during concerts and public appearances - thumb, index and pinky fingers extended, with the middle and ring fingers folded down. According to Simmons, this hand gesture was first used in commerce - by him - on Nov. 14, 1974. He is claiming the hand gesture should be trademarked for "entertainment, namely live performances by a musical artist [and] personal appearances by a musical artist." [16] Simmons abandoned this application on June 21, 2017 [17]

A fan displays the Hook 'em Horns during a Texas football game versus Arkansas.

Hook 'em Horns is the slogan and hand signal of the University of Texas at Austin. Students and alumni of the university employ a greeting consisting of the phrase "Hook 'em" or "Hook 'em Horns" and also use the phrase as a parting good-bye or as the closing line in a letter or story. The gesture is meant to approximate the shape of the head and horns of the UT mascot, the Texas LonghornBevo.

Fans of the University of South Florida Bulls use the same hand sign at their athletic events, except that the hand is turned around and facing the other way. With the middle and ring finger extending towards the person presenting the "Go Bulls" sign.

Fans of North Dakota State University Bison athletics also use a similar hand gesture, known as "Go Bison!" The pinky and index fingers are usually slightly bent, however, to mimic the shape of a bison's horns.

Fans of North Carolina State University Wolfpack athletics use a similar gesture with the middle and ring fingers moving up and down over the thumb to mimic a wolf's jaw.

Fans of University of Nevada, Reno Wolf Pack athletics use a similar sign with the middle and ring fingers out to resemble the wolf's snout.

Fans of University of Utah athletics, particularly football and gymnastics, use a gesture where the index and pinky finger are straight and parallel to each other, forming a block "U."[20]

Fans of Northwestern State University Demon athletics also use a similar hand gesture, known as "Fork 'em!" The pinky and index fingers are extended but a little more parallel to each other resembling the horns on a demon.

Arizona State UniversitySun Devil fans make a pitchfork sign by extending the index and middle fingers, as well as the pinky. The thumb holds down the ring finger to complete the gesture.

Fans of the Grand Canyon University Antelopes use this hand gesture with a slight variation by touching the tips of the ring and middle finger with the thumb to form the shape of an antelope and its horns. Often followed by the phrase "Lopes up".

Fans of the Universidad de Chile soccer team use this gesture to represent their support for the team by forming a U-shaped hand gesture, often followed by the phrase "Grande la U".

^ abAppleford, Steve (September 9, 2004). "Odyssey of the Devil Horns". Los Angeles City Beat. Archived from the original on November 22, 2007. A friend arranges a meeting with Clinton. I hand him a photograph of Dio making the hand signal, and tell him this is the man (or one of them) credited with bringing it to rock. Clinton stares at the picture for a long, silent minute, breathing heavily. Another minute passes. He's never heard of Ronnie James Dio. It's the P-Funk sign, man.

^Ronnie James Dio interview in the 2005 documentary Metal: A Headbanger's Journey. In the interview he also ridicules Gene Simmons for taking credit for originating use of the sign in heavy metal, attributing the claim to Simmons' well-known egotism.